PURPOSE: We evaluated whether prostate cancer patients receiving "Best Care" according to a set of five nationally endorsed quality measures had decreased treatment related morbidity and improved cancer control.
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METHODS: In this retrospective cohort study, we included 38,055 men from the Surveillance Epidemiology and End Results-Medicare database treated for localized prostate cancer between 2004 and 2010. For each patient, we determined whether he received "Best Care", defined as care adherent to all applicable measures. We measured associations of "Best Care" with need for interventions addressing treatment related morbidity and with need for secondary cancer therapy using Cox proportional hazards models.
RESULTS: Only 3,412 men (9.0%) received "Best Care". Five years after treatment, these men had a similar likelihood as men who did not receive "Best Care" to undergo procedures for urinary morbidity (e.g., 10.7% vs. 12.9%, p=0.338, for the subset of men who underwent prostatectomy) and secondary cancer therapy (e.g., 40.9% vs. 37.3%, p=0.522, for the subset of men who underwent prostatectomy for high-risk prostate cancer). However, they were more likely to have a procedure for sexual morbidity (e.g., 17.3% vs. 10.8%, p< 0.001, for men who underwent prostatectomy). Similar trends were observed among men treated with radiotherapy.
CONCLUSIONS: Overall, men receiving "Best Care" did not fare better with regards to treatment related morbidity and cancer control. Collectively, our findings suggest that the current process of care measures are not tightly linked to outcomes and that further research is needed to identify better measures that are meaningful and important to patients.
Schroeck FR, Kaufman SR, Jacobs BL, Hollenbeck BK. Are you the author?
1Division of Health Services Research, Ann Arbor, MI; Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, MI; Division of Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Division of VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont, Pittsburgh, PA; Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Reference: J Urol. 2014 Aug 6. pii: S0022-5347(14)04160-3.